High Blood Pressure Treatment Guidelines

Topic Overview

The U.S. National Institutes of Health publishes guidelines for doctors on high blood pressure classification and treatment. The guidelines are called the Seventh Report of the Joint National Committee (JNC 7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.1

If you have high blood pressure, your doctor will give you a blood pressure goal that is based on your health. For example, your goal will depend on whether you have other conditions such as diabetes, heart failure, coronary artery disease, or chronic kidney disease. Be sure you know your blood pressure goal.

Blood pressure classification

Blood pressure

Classification

140/90 or above

High

120/80 to 139/89

Prehypertension

119/79 or below

Normal

Treatment for high blood pressure

Blood pressure

Treatment

Blood pressure of 120–139 over 80–89 (prehypertension)

Lifestyle changes

High blood pressure of 140–159 over 90–99

Lifestyle changes, possibly medicines

High blood pressure of 160 over 100 or higher

Medicines plus lifestyle changes

High blood pressure plus organ damage or other risk factors for heart disease

Medicines plus serious lifestyle changes and treatment for the other health problems

Secondary high blood pressure

Medicines, treatment of the condition causing your high blood pressure, or both

African Americans

African Americans are more likely to develop high blood pressure and often have more severe high blood pressure than other groups. They also are more likely to have the condition at an earlier age than others. It is not known why they are at greater risk.

African Americans who are sensitive to salt (sodium), who are obese, or who smoke are at even higher risk for high blood pressure. As a result, African Americans with these risk factors tend to have more organ damage, such as kidney disease, heart attack, and enlargement of the heart, which can lead to heart failure (hypertensive heart disease). Lifestyle changes are especially important for this group.

Children

Children who have high blood pressure often continue to have high blood pressure as adults. Children ages 3 and older need to have their blood pressure monitored regularly during routine physical exams.

High blood pressure in children is rare but needs to be evaluated to find treatable causes. When a child has high blood pressure, it is more likely to be from a secondary cause—like a disease—than when an adult has high blood pressure.

High blood pressure in children should be treated with lifestyle changes and medicine if needed. A child with secondary high blood pressure also requires medicine. The risk of secondary high blood pressure is higher in children than in adults.

Older adults

Older adults often have isolated systolic high blood pressure. This problem is sometimes called ISH, for isolated systolic hypertension. In ISH, systolic blood pressure is above 140, but diastolic blood pressure stays lower than 90.

If you are older than 50, a systolic blood pressure (the upper number) over 140 is a more important risk factor for stroke and heart disease than your diastolic blood pressure (the lower number).

This type of high blood pressure is more common in older adults, especially older women. In fact, most people older than 60 who have high blood pressure have ISH.

ISH should be treated, because it can damage organs such as the brain, kidneys, heart, and eyes.

Your doctor may have you take a high blood pressure medicine such as a diuretic.

One problem with treating ISH is that some high blood pressure medicines can cause blood pressure to go too low, causing side effects like lightheadedness or a slow heartbeat. And older people are more likely to get these side effects. That's why it's important to monitor your blood pressure and to let your doctor know if you feel dizzy, lightheaded, or faint.

Prehypertension

If you have a blood pressure of 120 to 139 systolic (the upper number in a blood pressure measurement) over 80 to 89 diastolic (lower number), you have prehypertension. This is blood pressure that is higher than normal but not high enough to be high blood pressure. It is a warning that your blood pressure is going up. You need to begin lifestyle changes to lower your risk for stroke, heart disease, and other problems caused by high blood pressure. For more information, see the topic Prehypertension.

Secondary high blood pressure

Secondary high blood pressure treatment depends on the cause. For example, treatment of high blood pressure caused by kidney disease will also include treating the kidney problem. Even if the condition that caused your high blood pressure is treated, you may still have to take blood pressure medicine throughout your life.

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